CPT 23550Surgery

Optx acromclv dislc aqt/chrn

CPT 23550 covers surgical repair of a separated shoulder where the collarbone has dislocated from the shoulder blade at the acromioclavicular (AC) joint, whether the injury is recent (acute) or long-standing (chronic).

Showing rates for

National Average

Base Medicare rate

$568.97

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

7.59

PE RVU (NF)

8.53

MP RVU

1.47

Total RVU

17.59

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document acute versus chronic presentation explicitly in operative report with injury date and timeline
Impact: Prevents denials for medical necessity; chronic cases require documentation of failed conservative treatment (minimum 6 weeks) to justify surgical intervention
Report exact fixation technique and implants used (suture anchors, hook plate, TightRope, etc.) in operative notes
Impact: Supports medical necessity and differentiates from simpler procedures; enables accurate implant billing which can add $800-$2,500 in facility revenue
When performing coracoclavicular ligament reconstruction, verify that technique is included in 23550; do not separately bill ligament repair codes
Impact: Prevents unbundling denials and recoupment; CC ligament reconstruction is considered integral to AC joint repair
For bilateral procedures (modifier 50), ensure separate medical necessity documentation for each shoulder
Impact: Bilateral AC dislocations are rare; payers scrutinize these claims heavily and may reduce second side to 50% instead of standard 150% bilateral rate without compelling documentation
Submit claim within 90 days of service and verify preauthorization was obtained; AC joint repairs often require prior approval
Impact: Late filing can result in complete denial; lack of preauth may reduce payment by 50% or result in full denial with patient balance transfer risk
Code any documented Rockwood classification (Grade III-VI) in diagnosis coding and operative note to support severity
Impact: Higher-grade injuries (IV-VI) have stronger medical necessity justification and lower appeal rates; Grade III may face scrutiny for conservative treatment trial adequacy

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Frequently asked questions

What is the CPT code 23550 used for?

CPT 23550 is used for open surgical treatment of an acromioclavicular (AC) joint dislocation or shoulder separation, whether acute (recent injury) or chronic (long-standing). The procedure involves surgically exposing the separated joint, repositioning the collarbone, and stabilizing it with internal fixation such as sutures, plates, or screws.

How much does Medicare pay for CPT 23550 in 2025?

Medicare pays $568.97 for CPT 23550 in 2025 based on the national average non-facility rate. The facility rate is also $568.97. Actual reimbursement varies by geographic location due to locality adjustments and may be affected by modifiers such as bilateral procedures or increased complexity.

What is the difference between CPT 23550 and 23552?

CPT 23550 covers open treatment of AC joint dislocation (acute or chronic), while CPT 23552 specifically describes open treatment with fascial graft reconstruction. Code 23552 is used when the surgeon harvests or uses fascia lata or other graft material to reconstruct the coracoclavicular ligaments, representing a more complex procedure with higher reimbursement.

Can CPT 23550 be billed with a rotator cuff repair?

Yes, but with caution. CPT 23550 may be billed with rotator cuff repair codes (23410-23412) when both procedures are medically necessary and performed through separate approaches. Modifier 59 or XS should be appended to 23550, and documentation must clearly demonstrate distinct anatomic areas and independent medical necessity. Some payers may still bundle these codes.

What RVUs are assigned to CPT 23550?

CPT 23550 has 17.59 total RVUs for 2025, consisting of 7.59 work RVUs, 8.53 practice expense RVUs (both facility and non-facility), and 1.47 malpractice RVUs. These values reflect moderate surgical complexity and are used to calculate Medicare reimbursement using the conversion factor of 32.3465.

Does CPT 23550 require a modifier for left or right shoulder?

Yes, CPT 23550 requires an anatomical modifier (LT for left or RT for right) on every claim. Omitting this modifier will result in claim rejection or suspension by most payers. The modifier does not change the reimbursement amount but is mandatory for proper claim adjudication.

What diagnosis codes are typically used with CPT 23550?

Common ICD-10 codes include S43.101A-S43.109A for acute AC joint dislocation (specifying right, left, or unspecified shoulder and encounter type), S43.111A-S43.119A for AC joint subluxation, and S43.121A-S43.129A for sternoclavicular joint dislocation. For chronic cases, use S43.101S-S43.129S (sequela codes) along with M25.511-M25.519 for joint pain to document ongoing symptoms.